At Formula Feeding Helpline, we routinely counsel with women who have immense anxiety about giving birth and breastfeeding their newborn at a designated “Baby Friendly” Hospital. Unfortunate for many of them, they do not have a choice, since all of the hospitals in there geographic area are Baby Friendly.
So, what does Baby Friendly or BFHI mean? Why the fear and contempt?
“The Baby-Friendly Hospital Initiative (BFHI) was established in 1991 by the United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO). The BFHI is a global program to encourage and recognize birthing facilities that offer an optimal level of care for infant feeding and mother-baby bonding.”
Don’t be confused by the cute name. It’s not “baby friendly” any more than it is mom friendly.
BFHI is institutionalized breastfeeding bullying (lactivism) hidden under a guise of health promotion and female “empowerment”.
I would take no issue with BFHI if its purpose was simply to educate and support breastfeeding moms, as it claims. But the truth is much more sinister.
The BFHI Guidelines – to which designated hospitals must adhere – contain some 15 pages of rules and regulations that are necessary to receive federal funding. Yes, your tax dollars hard at work belittling new mothers.
Central to the designation and attached funding is the hospital’s ability to maintain high breastfeeding initiation and exclusive breastfeeding rates. That is, mothers and their babies are quantified, and a high percentage of them must breastfeed without the use of supplementation during their hospital stay for BFHI to reward the institution.
BFHI’s guidelines regarding what to do with moms who want to formula feed, either exclusively or with supplementation, are most egregious.
Behold, Guideline 6.1.
If you are giving birth in a BFHI-designated hospital, Guideline 6.1 says that staff is required to do the following to you:
“6.1 Guideline: When a mother specifically states that she has no plans to breastfeed or requests that her breastfeeding infant be given a breast milk substitute, the health care staff should first explore the reasons for this request, address the concerns raised, and educate her about the possible consequences to the health of her infant and the success of breastfeeding. If the mother still requests a breast milk substitute, her request should be granted and the process and the informed decision should be documented. Any other decisions to give breastfeeding infants food or drink other than breast milk should be for acceptable medical reasons and require a written order documenting when and why the supplement is indicated.”
Please take note of this series of events.
A mother who does not want to breastfeed, or who wants to supplement breast milk with formula, is not to be treated as an aware and responsible human being capable of making a decision.
First, she is to be asked why she is making the decision she is making (which is insulting).
Next, she will be asked to share her concerns and have them “addressed” (invalidating her).
Next, she is to be educated about the consequences of her decision on her infant’s health. Like every mom of a 1-day-old wants a made-up spiel of how she’s dooming her kid for life? And to what health consequences are we referring? For term infants, the benefits of breast milk are small, contained to the first year of life, and dramatically confounded by outside variables that influence breastfeeding rates, like a mom’s socio-economic status.
After the staff member has questioned the mother’s intentions and lectured her, if she asks AGAIN for the formula, she will be allowed to have it.
And this is what the BFHI calls “informed” decision making.
BFHI’s reluctance to embrace the safety and benefits of newborn supplementation (or prelacteal feeding) has had devastating effects, including higher rates of babies be readmitted to the hospital for starvation-related conditions such as excessive weight loss, dehydration, jaundice, and hypernatremia. In some cases these conditions are life-threatening and absolutely avoidable.
BFHI goes further by not condoning the use of bottles for supplemental feeding, or the use of pacifiers for soothing (Guidelines 9.1 and 9.2, respectively). If the mom makes either request, then the series of events from Guideline 6.1 apply.
The mother is to be questioned, asked to justify her request for the bottle or pacifier, lectured as to why she should not make the decision and the dangers of doing so, and only if she persists with her request a second time is she to be given the bottle or pacifier.
How you can plan for it:
Let me state that while there are horror stories that women have experienced at BFHI-designated hospitals – it is by no means a guarantee that you will experience the same in the BFHI hospital where you are giving birth. What you need to understand is Guideline 6.1, to which staff is bound by, and how that guideline can potentially affect you.
Eight out of 10 new moms want to initiate breastfeeding, but many do not want the pressures and restrictions that BFHI imposes upon them and their breastfeeding “performance” while in the hospital.
Many want to freely use pacifiers and supplement as they deem fit, without a dramatic experience during an already sensitive time.
There is a little “trick” used to circumvent BFHI’s immense restrictions, allowing moms a more comfortable and autonomous inpatient hospital stay.
Upon intake, you very directly tell the hospital staff that you are an exclusively formula feeding mom and that you will not be breastfeeding.
In doing this you have automatically blown their breastfeeding initiation and exclusivity statistics, and they will move along from you very quickly, often skipping the Guideline 6.1 nonsense altogether. In short, you’re a lost cause and any efforts spent hassling you aren’t worth it; there are other women to try and woo to up the numbers. They will relent and provide you with all the formula you need without constant annoyance every time you choose to supplement.
From here, you nurse your baby. You nurse your baby on demand and whenever you want.
And you supplement with formula whenever and however you want.
If you are having breastfeeding troubles or latching issues and would benefit from a lactation consultation, you set up a private one (an outside lactation consultant comes to your hospital room), or you wait until discharge (only 48 hours in most cases and before copious amounts of milk arrives) and seek out services at your baby’s pediatrician’s office. These offices overwhelmingly staff lactation consultants as part of their health care delivery.
You get to nurse in peace. You get to formula feed in peace. Your baby gets what YOU decide she needs. You get open access to pacifiers. You get to be an autonomous mother who can make her own decisions.
For women who have already had traumatic experiences trying to breastfeed in BFHI-designated hospitals, this tactic can provide huge relief.
Likewise, if you want to ability to freely supplement your baby – knowing full-well that it will not doom your future breastfeeding success – you may want to consider it.
As always, contact us today if you’re in need of formula feeding help or support.